Global Society

ISSN: 1360-0826 (Print) 1469-798X (Online) Journal homepage: https://www.tandfonline.com/loi/cgsj20

One Bioregion/One Health: An Integrative

Narrative for Transboundary Planning along the
US–Mexico Border

Keith Pezzoli, Justine Kozo, Karen Ferran, Wilma Wooten, Gudelia Rangel
Gomez & Wael K. Al-Delaimy

To cite this article: Keith Pezzoli, Justine Kozo, Karen Ferran, Wilma Wooten, Gudelia Rangel
Gomez & Wael K. Al-Delaimy (2014) One Bioregion/One Health: An Integrative Narrative for
Transboundary Planning along the US–Mexico Border, Global Society, 28:4, 419-440, DOI:
10.1080/13600826.2014.951316

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Global Society, 2014
Vol. 28, No. 4, 419–440, http://dx.doi.org/10.1080/13600826.2014.951316

One Bioregion/One Health: An Integrative Narrative for

Transboundary Planning along the US–Mexico Border

KEITH PEZZOLI, JUSTINE KOZO, KAREN FERRAN,

WILMA WOOTEN, GUDELIA RANGEL GOMEZ and
WAEL K. AL-DELAIMY

Global megatrends—including climate change, food and water insecurity, economic crisis,
large-scale disasters and widespread increases in preventable diseases—are motivating a
bioregionalisation of planning in city-regions around the world. Bioregionalisation is an
emergent process. It is visible where societies have begun grappling with complex socio-
ecological problems by establishing place-based (territorial) approaches to securing
health and well-being. This article examines a bioregional effort to merge place-based
health planning and ecological restoration along the US–Mexico border. The theoretical
construct underpinning this effort is called One Bioregion/One Health (OBROH).
OBROH frames health as a transborder phenomenon that involves human–animal–
environment interactions. The OBROH approach aims to improve transborder knowledge
networking, ecosystem resilience, community participation in science–society relations,
leadership development and cross-disciplinary training. It is a theoretically informed
narrative to guide action. OBROH is part of a paradigm shift evident worldwide; it is
redefining human–ecological relationships in the quest for healthy place making. The
article concludes on a forward-looking note about the promise of environmental
epidemiology, telecoupling, ecological restoration, the engaged university and bioregional
justice as concepts pertinent to reinventing place-based planning.

Introduction
The 21st century’s socio-economic, ecological and environmental public health pro-
blems are increasingly complex and globally interwoven.1 Our capacity to address
these problems (e.g. climate change, food and water insecurity, economic crisis,
large-scale disasters and widespread increases in preventable diseases) hinges on
our ability to foster authentic and equitable collaboration among diverse, some-
times conflicting, interests. Narratives are key to framing collaborative efforts.2
This article sketches a narrative called One Bioregion/One Health (OBROH). The
1. Bill McKibben, Earth: Making a Life on a Tough New Planet (New York: Time Books, 2010);
F. Biermann, K. Abbott, S. Andresen, K. Bäckstrand et al., “Navigating the Anthropocene: Improving
Earth System Governance”, Science, Vol. 335, No. 6074 (2012), pp. 1306–1307.
2. Semour J. Mandlebaum, “Narrative and Other Tools”, in Barbara J. Eckstein and James
A. Throgmorton (eds.), Story and Sustainability: Planning, Practice, and Possibility for American Cities (Cam-
bridge, MA: MIT Press, 2003), ch. 8.

© 2014 University of Kent

420 Keith Pezzoli et al.

OBROH narrative interweaves (1) emergent discourse in urban and regional plan-
ning that focuses on the built environment in relationship to health (e.g. urban
design for walkability and active living, watershed management for pollution pre-
vention) with (2) emergent discourse in public health and epidemiology that
widens the circle of concern for human health to include human–animal–environ-
ment interactions. These two discourses have begun to document how ecosystem
integrity is vital to human as well as non-human health. In this light, ecological res-
toration is becoming an important part of the health equation. Utilising the US–
Mexico border as a case in point, this article cites examples of how OBROH has
been embraced to promote environmental health, security and justice. The focus
is on initiatives aimed at improving health outcomes on both sides of the border
by improving transboundary institutional networking, risk assessment, monitor-
ing, communication and ecological restoration.
Ecological restoration “is the process of assisting the recovery of an ecosystem that
has been degraded, damaged, or destroyed.”3 Restoration is typically applied as an
act of renewal, revival or reinvigoration to enhance the ability of ecosystems to
change as their environments change. Ecological restoration is driven by a range
of organisations with diverse interests, including wilderness managers striving for
high levels of ecological integrity; ranchers needing sustainable soils; and residents
of sister cities such as San Diego in the United States and Tijuana in Mexico who want
clean, reliable water supplies and a healthy environment. Urban ecological restor-
ation is a critical need for US–Mexico border residents because border communities
face heightened environmental and public health risks associated with ecosystem
degradation (e.g. risks arising from floods, fire, dust, water contamination and
newly emergent disease vectors).4 Ecological restoration in urban areas, as part of
a broader bioregional/watershed approach as articulated by OBROH, can increase
the positive impacts of restored soils, air and watersheds, as well as provide many
important socio-economic and health benefits.

The US–Mexico Border Region

There are many places worldwide where urban growth contiguously spans an
international border. These “transfrontier metropolises”5 often have health risks
in common on both sides of the border. The US–Mexico border region—defined
as a swath of land 100 kilometres north and 100 kilometres south of the entire inter-
national boundary—has an estimated 15 million people mostly concentrated in 14
binational sister cities. The border extends 3,168 kilometres with 52 legal land cross-
ing points (a place where a vehicle can travel by road or rail from US to Mexican
territory).6 It is one of the busiest international land frontiers in the world.
3. Society for Ecological Restoration, “SER International Primer on Ecological Restoration”, cited 18
June 2014, available: <http://www.ser.org/resources/resources-detail-view/ser-international-primer-on-
ecological-restoration> (accessed 18 June 2014).
4. US Environmental Protection Agency, Border 2012: US–Mexico Environmental Program, “State of
the Border Region Indicators Report”, available: <http://www2.epa.gov/border2020/indicators-report>
(accessed 18 June 2014).
5. Lawrence A. Herzog, “Cross-National Urban Structure in the Era of Global Cities: The US–Mexico
Transfrontier Metropolis”, Urban Studies, Vol. 28 (1991), pp. 519–533.
6. Research Institute, Western Washington University, “Atlas of the Land Entry Ports on the US–
Mexico Border”, Border Policy Brief, 2010, available: <http://www.wwu.edu/bpri/files/2010_Fall_
Border_Brief.pdf> (accessed 26 June 2014).
 Transboundary Planning along the US–Mexico Border 421

The Good Neighbor Environmental Board (GNEB), an appointed independent

US federal advisory committee, has been addressing environmental issues along
the US–Mexico border for over 15 years.7 The GNEB’s mission is to advise the
US president and Congress on good neighbour practices and issue an annual
report with recommendations focused on environmental infrastructure needs
within the US states contiguous to Mexico. The 16th annual GNEB report—sched-
uled for publication in late 2014—will focus on ecological restoration. GNEB
members determine the specific content of the annual reports in a deliberative
process open to the public. One recommendation under consideration for the
2014 report is a call to support ecological restoration in transborder metropolitan
areas where urban sprawl is taking place, such as the canyon lands of Tijuana
and the river valley of Ciudad Juarez. Recommendations of this sort suggest
ways to cross-pollinate the twin objectives of transboundary environmental man-
agement and healthy city-region planning.
The health of the Tijuana River Estuary, to cite one illustration, hinges on what
happens upstream in the binational Tijuana River Watershed (TRW), a large
4,465 square kilometre watershed two-thirds of which lies in Mexico and one-
third in the US. The estuary drains the TRW. Sediment, waste tyres, raw sewage,
contaminated storm water and invasive species all flow into the estuary from the
rapidly urbanising watershed. These inputs have been recognised, and manage-
ment with a watershed approach (i.e., place-based strategies that take into
account biogeography and water flow paths) is currently getting much attention
at the Tijuana River. Two notable collaborative efforts include the Tijuana River
Valley Recovery Team and the International Boundary and Water Commissions
Watershed Initiative effort for the Tijuana River Valley. Using the watershed as
the unit of analysis and framework for intervention is important when addressing
ecological restoration and environmental public health. The Tijuana River Valley is
home to a variety of birds and other wildlife but it is not only biodiversity that is at
risk. Human health is also potentially at risk. The estuary is a filter but it is an over-
loaded filter and the health of the communities surrounding the estuary depends
on the health of the estuary. The estuary is also home to antibiotic-resistant bacteria
and mosquitoes that could carry West Nile, dengue and yellow fever.8 Water con-
taminated with sewage often flows into the estuary, leading to beach closures north
of the river mouth on the US side of the border (notably in Imperial Beach, the
Tijuana Slough National Wildlife Refuge, and Border Field State Park).
The contiguously urbanised Mexicali–Calexico transborder metropolis (Mexicali
being on the Mexican side, Calexico on the US side) is another of the border region’s
twin cities. The Mexicali–Calexico twin city is located in a shared valley region
known as the Mexicali Valley on the Mexico side and the Imperial Valley on the
US side. The New River that runs through this twin city is one of the most polluted
in the United States.9 Its south-to-north flow through the valley from Mexico into the
US, ending up in the Salton Sea, drains agricultural and urban runoff containing pes-
ticides, raw sewage, industrial waste and many other contaminants. Although there

7. See GNEB website: <http://www.epa.gov/ocempage/gneb/gneb_president_reports.htm>.

8. Mike Vizzier, Chief of Hazardous Materials Division, Department of Environmental Health, San
Diego County, personal communication, 19 March 2014.
9. New River Improvement Project Technical Advisory Committee (TAC), “Strategic Plan: New River
Improvement Project”, Special Assistant Nilan Watmore (ed.), California Environmental Protection
Agency, California–Mexico Border Relations Council, 2011.
422 Keith Pezzoli et al.

are no epidemiological studies to demonstrate it, residents along the path of the New
River on the US side attribute clusters of cancer to the toxicants in the waterway.10
Efforts to scientifically link such cancers to the New River have been hampered by
the difficulty of determining the degree of human exposure to the toxicants
carried by the river. Cancer develops over decades and a large number of cancer
cases with appropriate exposure assessment and lifestyle history are needed to
delineate such an association. A large population of Mexican residents in Mexicali
is probably exposed to similar contaminants from the New River. A bioregional-
scale epidemiological study along the New River on both sides of the border
would help shed light on the health risks faced by people living in the shared valley.
The two examples noted above (urban growth in the Tijuana River Valley and
along the New River) underscore the potential value of promoting healthy city
planning within a bioregional framework.

Healthy City Planning

Healthy city planning addresses how socio-ecological conditions (e.g. environ-
mental quality, poverty, education levels, public safety, human settlement patterns)
shape patterns of death and disease including the expression of biologic traits,
population distributions of disease, and social inequalities in health. Jason
Corburn describes how society and the field of public health have a tendency to
search “for one big cause or explanation of differences in health outcomes across
populations, from nineteenth-century theories of miasma and contagion to
medical care and genetic explanations of the twenty-first century.”11 It is now pro-
posed that this issue is far more complicated. The US–Mexico border region is a
prime place to integrate healthy city planning and the concept of One Health
within a bioregional framework. One Health advocates argue, “larger and more
sustainable health benefits will result if research and interventions are collaborative
across human, animal (domestic and wildlife), and ecosystem health sectors
rather than targeted at each of these factors individually and in isolation from
each other.”12
Urban health researchers and professionals are exploring “how a combination
of place-based physical, economic and social characteristics and the public policies
and institutions that shape them—not just genetics, lifestyles or health care—are
the cause of inequitable distributions of well-being in cities.”13 Public health
researchers refer to epigenetics, which suggests that genetic expression (which
can give rise to cancer or other diseases) or cellular phenotype (observable phys-
ical characteristics or traits) may be caused by mechanisms other than DNA—for
instance environmental exposures. Epigenetics is defined as a bridge between
genotype (the inherited instructions embodied within an organism’s genetic
code) and phenotype and is a phenomenon that changes the final outcome of a
10. Perlita R. Dicochea, “Between Borderlands and Bioregionalism: Life-Place Lessons along a Polluted
River”, Journal of Borderlands Studies, Vol. 25 (2010), pp. 19–36.
11. Jason Corburn, Toward the Healthy City: People, Places, and the Politics of Urban Planning, Urban and
Industrial Environments Series (Cambridge, MA: MIT Press, 2009), p. 3; emphasis added.
12. Patricia A. Conrad, Laura A. Meek and Joe Dumit, “Operationalizing a One Health Approach to
Global Health Challenges”, Comparative Immunology, Microbiology and Infectious Diseases, Vol. 36
(2013), pp. 211–216 (at p. 211).
13. Corburn, Toward the Healthy City, op. cit., p. 4.
 Transboundary Planning along the US–Mexico Border 423

locus or chromosome without changing the underlying DNA sequence.14 In other

words, our health is not entirely hard wired genetically speaking (i.e., there is
some plasticity in gene expression that goes beyond what we inherit from our
parents). Public health researchers are beginning to take into account cumulative
health risks posed by environmental exposures, stress, diet and behaviour. From
this perspective, the qualities of a place (as measured, for instance, by the con-
dition of its air, water, land, safety, neighbourliness, access to fresh fruits and veg-
etables, built environment and infrastructure for active living like walking and
biking) are key determinants of health.15 Herein lies the theoretical and practical
justification for merging the One Bioregion concept with the One Health concept

One Bioregion/One Health

The One Bioregion/One Health (OBROH) narrative frames health as a transborder
phenomenon involving human–animal–environment interactions. The OBROH
approach aims to improve transborder knowledge networks, ecosystems, green
infrastructure, community participation, science–society relations, leadership
development, cross-disciplinary training and innovation. It is a theoretically
informed narrative to guide action. OBROH is part of a paradigm shift evident
worldwide; it is redefining human–ecological relationships in the quest for
healthy and resilient place making (see Figure 1).16
OBROH reflects a growing understanding that the risks to health are multiple
and cumulative. This new approach to healthy urban and regional planning goes
beyond identifying individual biology and behaviours as the causal factors deter-
mining health disparities and well-being. This new approach emphasises how built
environments (e.g. housing, modes of transportation, green infrastructure, spaces
for walking, biking and active living) and population health interact—all within
the regional biogeography and ecosystems of particular places.

The Bioregionalisation of Health Policy and Planning

Scholars are calling for more place-based ecological integrity along borders where
city-regions have in effect become transfrontier societies.17 The OBROH narrative is
one of the responses to this quest to achieve ecological integrity through place-
14. J.M. McGinnis and W.H. Foege, “Actual Causes of Death in the United States”, Journal of the Amer-
ican Medical Association, Vol. 270, No. 18 (1993), pp. 2207–2212.
15. J.M. McGinnis and Brian W. Powers, “Healthy People and the Design Sciences: The Robert Wood
Johnson Foundation Advances the Frontier”, American Journal of Preventive Medicine, Vol. 43 (2012),
pp. 407–409; J.A. Patz et al., “Human Health: Ecosystem Regulation of Infectious Diseases”, in
R. Scholes and N. Ash (eds.), Ecosystems and Human Well Being: Current State and Trends: Findings of the Con-
ditions and Trends Working Group by Millennium Ecosystem Assessment (Washington, DC: Island Press, 2005),
pp. 123–142.
16. John Friedmann, “Place and Place-Making in Cities: A Global Perspective”, Planning Theory & Prac-
tice, Vol. 11 (2010), pp. 149–165; Andrew L. Dannenberg, Howard Frumkin and Richard Jackson, Making
Healthy Places: Designing and Building for Health, Well-Being, and Sustainability (Washington, DC: Island
Press, 2011); Jason Corburn, Healthy City Planning: From Neighbourhood to National Health Equity, Planning,
History and Environment Series (New York: Routledge, 2013).
17. Lawrence A. Herzog, Shared Space: Rethinking the US–Mexico Border Environment, US–Mexico Con-
temporary Perspectives Series (La Jolla, CA: Center for US–Mexican Studies, University of California,
San Diego, 2000).
424 Keith Pezzoli et al.

Figure 1. One Bioregion/One Health: Domains, Activities, and Outcomes.

based approaches. At the heart of bioregional theory and practice is this core
guiding principle: human beings are social animals; if we are to survive as a
species we need healthy relationships and secure attachments with one
another and with the land, waters, habitat, plants and animals upon which we
depend. This is not a new principle; bioregional scholars, ethicists, poets and
leaders of bioregional movements around the world have been embracing it for
decades.18
Bioregion as a term combines the Greek word for life (bios) with the Latin word
for territory (regia) and the Latin term for ruling/governing (regere). Bioregion thus
means “life territory” or “lifeplace.” The bioregionalisation of health policy and
planning faces three major challenges: (1) Rebuilding urban and rural commu-
nities—on a human scale—to nurture a healthy sense of place, secure attachments
and rootedness among community inhabitants; (2) Reintegrating nature and
human settlements in ways that holistically instil eco-efficiency, resilience, equity
and green cultural values into systems of production, consumption and daily
life; and (3) Making known (and valuing) how wildlands, working landscapes, eco-
logical services and rural livelihoods enable cities to exist. To meet these three chal-
lenges, bioregionalists advocate localisation. Localisation includes strategies
designed to create sustainable and resilient communities on a human scale by fos-
tering local investments in nearby natural resources, rooted livelihoods and

18. The Planet Drum Foundation (www.planetdrum.org) and the Bioregional Congress (www.
bioregionalcongress.net) have been documenting and archiving the congresses. An increasing number
of universities now offer degrees in bioregionalism, including many in the USA (e.g., University of
Idaho; Utah State University; University of California, Davis; Montana State University; and University
of Pennsylvania). Bioregional programmes can also be found at universities in Mexico, Asia, Europe and
Australia among other places.
 Transboundary Planning along the US–Mexico Border 425

institutions thereby augmenting a community’s assets (including community

power/capabilities).19
The spatial scale of bioregional initiatives varies. Bioregionalists focus on
watersheds (“ridge top to ridge top”), multiple watersheds (“landscape scale”),
river basins and even much larger swaths of the earth’s surface. These scales
are nested one within the other. Peter Berg and Raymond Dasmann coined
the most widely cited definition of a bioregion; they describe it as referring to
both a geographical terrain and a terrain of consciousness. In other words, the
boundary that makes up a particular bioregion is not strictly determined by
the lay of the land (i.e. its geography or biome). The bioregion also has a cultural
dimension shaped by how people live in and identify with the place.20 Bioregio-
nal boundaries, as defined by local inhabitants themselves, thus take a range of
factors into account—most often including climate, topography, flora, fauna, soil
and water together with the territory’s socio-cultural characteristics, economy
and human settlement patterns. Robert L. Thayer, Jr., a widely noted bioregional
activist-scholar, aptly argues, “the bioregion is emerging as the most logical
locus and scale for a sustainable, regenerative community to take root and to
take place.”21
The United States Geological Survey (USGS) is using watershed boundaries for
its Border Environmental Health Initiative Regions project (see Figure 2). The USGS
chose this delineation rather than the administrative boundary established by the
1983 La Paz agreement, which defines the border region as the area extending
100 kilometres north and 100 kilometres south of the international boundary
line. The USGS rationale for this decision is that watersheds provide more
meaningful and useful units of analysis when tackling transboundary socio-
ecological challenges.

The Border Health Initiative Regions project has two main goals:

1. Develop and maintain a US–Mexico Border Transboundary Geographic Infor-

mation System (GIS) and natural resource databases to help researchers, govern-
ment officials, planners and concerned citizens to make decisions concerning the
US–Mexico border region.
2. Investigate linkages between the condition of the physical environment and
health including how environmental changes, contaminant trends, human
and wildlife health interrelate.22

Bioregional initiatives conducted on national, binational and international scales

do not necessarily advance the more challenging aspects of bioregionalism (e.g.
authentic participatory democracy, communitarianism, subsidiarity, mutual aid).
Yet national and international efforts are helping to reframe public discourse,
19. Raymond De Young and Thomas Princen, The Localization Reader: Adapting to the Coming Downshift
(Cambridge, MA: MIT Press, 2012).
20. Peter Berg and Raymond Dasmann, “Reinhabiting California”, Ecologist, Vol. 7 (1977), p. 8.
21. Robert L. Thayer, Lifeplace: Bioregional Thought and Practice (Berkeley, CA: University of California
Press, 2003), p. 55.
22. US Geological Survey, “USGS US–Mexico Border Environmental Health Initiative”, Web Mapping
Application byFederal_User_Community, June 2013, available: <http://www.arcgis.com/home/item.
html?id=496864a948ca4ed4a3ecccd0f24df2a7>(accessed 23 November 2013).
426 Keith Pezzoli et al.

Figure 2. Eight Border Health Initiative Regions (Aligned along Watershed Boundaries) as
Defined by the US Geological Survey.
Source: US Geological Survey, “Ecological Regions of the US–Mexico Border”, US–Mexico
Border Environmental Health Initiative (January 2011), available: <http://borderhealth.cr.
usgs.gov/staticmaplib.html> (accessed 23 November 2013).

thereby creating new opportunities to advance bioregionalism’s core commitments,

including ecological restoration in urban and rural settings as well as in protected
areas and working landscapes. This trend is evident in the 2013–2014 GNEB
deliberations.23
The OBROH approach builds on bioregional theory and the work of those
who have advocated “One Border/One Health” (OBOH). By intentionally inte-
grating bioregional theory, principles of ecological restoration and One Health,
the OBROH approach can help us get beyond two types of bias that constrain
efforts to realise the kind of paradigm shift we need to bring about healthy
place making and sustainability. The two biases are: (1) metrocentric—a fixation
on cities in a way that ignores or undervalues the socio-ecological systems
that interdependently bind urban and rural lifeplaces; and (2) anthropocentric—
a failure to adequately take into account how human, animal and plant health
are increasingly interconnected. The One Health paradigm acknowledges that
human health is inseparable from the health of animals and the planet as a
whole.24

23. The US–Mexico Good Neighbor Environmental Board has considered bioregional theory and prac-
tice in its current deliberations to improve ecological restoration along the border. Similarly, the Super-
fund Research Program of the US National Institute of Environmental Health Sciences (NIEHS) is
supporting a transborder bioregional initiative led by the University of California, San Diego and
Alter Terra, a binational non-governmental organisation.
24. Kelley Lee and Zabrina L. Brumme, “Operationalizing the One Health Approach: The Global Gov-
ernance Challenges”, Health Policy and Planning, Vol. 28, No. 7 (1 October 2013), pp. 778–785.
 Transboundary Planning along the US–Mexico Border 427

One Health in Theory and Practice

Those advocating a One Health perspective are quick to point out that humans,
domestic animals, wildlife and plants are all interconnected with, and dependent
on, the environment they inhabit. This idea of interconnectedness has recently
gained recognition and popularity, but the idea goes back millennia. Human and
animal health is affected, directly and indirectly, by the health of planetary ecosys-
tems, which provide necessary food, air, water and protection.25 Intact ecosystems
play an important role in maintaining a diversity of species in balance and regulat-
ing the transmission of many infectious diseases. While human activity has
impacted ecosystems for thousands of years, the past century has witnessed unpre-
cedented rapid human population growth and economic development, driving
extensive ecological changes and the emergence of both new and previously recog-
nised infectious diseases. These activities include the encroachment into or destruc-
tion of wildlife habitat, agricultural land use changes, deforestation and habitat
fragmentation, uncontrolled urbanisation, construction of dams and irrigation
canals, release of chemical pollutants, intensive livestock production, climate
changes, international travel and trade and human migration and settlement, as
well as the emergence of new disease vectors, in the wake of increasingly globalised
flows of life forms and other materials.
Over the past few decades, the emergence of human immunodeficiency virus
(HIV), severe acute respiratory syndrome (SARS), H5N1 avian influenza, the
2009 H1N1 influenza pandemic and the re-emergence of extensively drug-resistant
tuberculosis, dengue and cholera have clearly demonstrated the threat these global
health challenges pose to health security. Quite recently, two additional novel
viruses have emerged—the H7N9 influenza virus and Middle East Respiratory
Syndrome Coronavirus (MERS-CoV)—causing concern to public health experts
worldwide. In today’s interconnected world, “in the context of infectious diseases,
there is nowhere in the world from which we are remote and no one from whom we
are disconnected.”26 Underlying this threat is the awareness that while the initial
response to any infectious disease outbreak is primarily the responsibility of the
domestic government, infectious diseases do not respect national borders and the
failure of control measures in one country has the potential to put neighbouring
countries and the health security of the entire world at risk. The spread of zoonotic
diseases in the late 20th century and early 21st century has inspired a new disci-
pline known as “Global Health.” Global Health approaches environmental
public health as a transborder phenomenon and thus fits well within the
OBROH narrative presented here.
Recognising the globalisation of health risks, and the threat of bioterrorism post
9/11 following the anthrax letters, the US Assistant Secretary of Preparedness and
Response funded the Early Warning Infectious Disease Surveillance (EWIDS)
Program in 2003 to build early warning systems to detect both intentional and
natural disease threats along US international borders. The overarching goal of
EWIDS was to improve cross-border early warning of infectious diseases in
North America and build the capacity of public health systems in the US border

25. Patz et al., op. cit.

26. Institute of Medicine (US) Committee on Emerging Microbial Threats to Health, “Preface”, in
J. Ledergerg, R.E. Shope and S.C. Oaks (eds.), Emerging Infections: Microbial Threats to Health in the
United States (Washington, DC: National Academies Press, 1992), p. v.
428 Keith Pezzoli et al.

states with a focus on infectious disease with a major public health impact (e.g. bio-
terrorism agents, emerging and re-emerging pathogens, pandemic influenza).
Critical to EWIDS’ success in addressing the complexities of cross-border disease
outbreaks was close collaboration with public health partners in neighbouring
border states and coordination of efforts to detect and respond more effectively
to infectious disease threats.
The California–Baja California border region encompasses a wide range of eco-
systems, topography, dense urban areas and agricultural developments that coexist
in a limited geographic area and create numerous human–animal–environmental
interfaces. These interfaces pose a significant risk to animal, human, environmental
and plant health, as evidenced by frequent wildlife die-offs, antibiotic-resistant bac-
teria in streams, beach closures due to faecal contamination, pesticide toxicities,
zoonotic infectious disease outbreaks and vector-borne diseases.27 With the
increasing awareness that prompt detection, diagnosis and response to newly
emerging infectious diseases requires working outside of traditional disciplinary
silos and forging new multi-sectoral partnerships, and the recognition of the
marked absence of any organisation comprehensively addressing the health risks
posed by these complex interfaces, EWIDS founded One Border/One Health
(OBOH) in June 2011. This effort connected individuals representing multiple
sectors in the California–Baja California region in order to address emerging dis-
eases, risk factors contributing to the region’s susceptibility, and actions to
monitor and intervene such as establishing joint animal–human surveillance
systems for early warning of emerging infectious diseases. Cooperating across
both jurisdictional and sectorial boundaries and the formation of groups such as
the OBOH are critical to creating sustainable solutions to health risks at the
human–animal–environmental interface and building resilient communities.28
The OBOH was successful in encouraging scholars and practitioners to work col-
laboratively in order to establish a process for (1) enhancing surveillance for emer-
ging and re-emerging pathogens using the One Health concept, (2) developing
mechanisms for data collection and exchange among stakeholders, and (3)
raising community awareness to integrate the One Health concept in education
and training.29 Table 1 summarises key features of the One Border/One Health

27. An example of this can be seen in the re-emergence of tuberculosis cases in the form of Multi-Drug
Resistant Tuberculosis (MDR-TB). This is a major global threat that significantly affects US border cities
including San Diego, which suffers double the national US average prevalence of MDR-TB. See World
Health Organization, “Multidrug-Resistant Tuberculosis (MDR-TB)”, October 2013, available: <http://
www.who.int/tb/challenges/mdr/en/> (accessed 25 November 2013); Betsy McKay, “Risk of Deadly TB
Exposure Grows along US–Mexico Border”, 8 March 2013, available <http://online.wsj.com/news/
articles/SB10001424127887323293704578336283658347240> (accessed 25 November 2013). Also see
Robert Donnelly, Our Shared Border: Success Stories in US–Mexico Collaboration (Washington, DC:
Border Research Partnership/Woodrow Wilson International Center for Scholars, January 2012); and
M.F. Moreau et al., “Selenium, Arsenic, DDT and Other Contaminants in Four Fish Species in the
Salton Sea, California, Their Temporal Trends, and Their Potential Impact on Human Consumers and
Wildlife”, Lake and Reservoir Management, Vol. 23 (2007), pp. 536–569.
28. One Border One Health, A California-Baja California Regional Network, available: <http://www.
oneborderonehealth.com/> (accessed 23 November 2013).
29. The progress of these collaborative efforts has been presented at numerous professional confer-
ences including presentations at the Second International One Health Conference; the International
Society for Disease Surveillance Annual Conference; the Dynamics of Preparedness Conference; the
National Environmental Health Association Annual Conference; the National Hispanic Medical Associ-
ation Resident Leadership Program; the General Meeting of the American Society for Microbiology; and
 Transboundary Planning along the US–Mexico Border 429

Table 1. Key Features of One Bioregion/One Health.

Key Feature Benefit

Transborder • Facilitates bioregional planning through

Holistic
Multi-disciplinary and Cross-sectoral
collaboration
Transparency in processes and decision •
making • Encourages data sharing
• Optimises resources and efforts
Platform for information exchange and •
discussion • Creates a network linking distributed
Effective champions, sponsors and
formal leadership positions (co-
chairs)
Cross-cultural understanding
Chatham House Rules
Participation of federal and state actors •
Collaborative binational committees
integrated watershed management
• Improves surveillance and response to health
threats
• Improves binational communication
• Refocuses disease-centred approach with a
proactive, wellness, system-based approach
• Shifts from species-specific to multiple species/
habitat conservation and restoration
approaches
• Values human health, animal health and the
environment
• Examines how place-based physical, economic
and social characteristics interact
• Creates a culture of interdependence
• Disrupts traditional silos; designs interventions
for collective impact
• Shares knowledge, best practices and protocols
• Creates synergy among different institutional
perspectives and experiences
• Promotes flexible and rapid responses to
threats
• Integrates diverse forms of knowledge and
action through multisector, multiscale and
multidisciplinary collaboration (3Ms).
Builds trust-based relationships and legitimacy
Improves communication and sharing of ideas
intelligence
• Leverages the power of spatial analytics,
visualisation and multimedia
• Ensures objectives are met
• Access to resources and networks
• Ability to influence other organisations
• High level of active participation
• Builds legitimacy
• Seeks common ground
• Culturally appropriate strategies
• Encourages free discussion
• High level of active participation
Fosters political will and high-level support
• Directs interactive problem solving
• Creates the opportunity for bioregional
planning
• Builds capabilities for inter-sectoral
collaboration
• Creates a common vocabulary

Continued
430 Keith Pezzoli et al.

Table 1. Continued.

Key Feature Benefit

Training, education and outreach • Increases community awareness

Evaluation of collaborative process
Bioregional scale
• Provides community with bioregional
information
• Builds workforce capacity
• Aids in recruitment of new members and
partner organisations
• Identifies strengths and weaknesses in
collaborative process
• Informs continuous initiative evolution and
improvement
• Improves retention of membership
• Creates a contextual understanding and focus
on local humans and animals and their social
and ecological environment
• Improves flexibility, resilience, adaptability
and timely responsiveness at the local and
bioregional scale
• Relates place-based health planning to
ecosystem management

approach. The table uses the term “One Bioregion” as opposed to “One Border” in
its title to emphasise the place-based nature of the relationship, including the value
added by the new politics of bioregionally oriented healthy city planning.

One Health in Global Perspective

In addition to North America, the value of collaborative cross-border regional net-
works has been demonstrated in other areas of the world. The Human Animal
Infections and Risk Surveillance (HAIRS) is a government-funded multi-agency
and cross-disciplinary horizon-scanning group covering England, Wales, Scotland
and Northern Ireland.30 The group has met every month since 2004 and acts as a
forum to identify and assess infections with potential for interspecies transfer
that may pose a risk to animal or human health. The countries around the Mediter-
ranean Sea started the EpiSouth Project in 2006, as a framework for collaboration
for communicable disease surveillance and training among 26 participating
countries from southern Europe, the Balkans, North Africa and the Middle East
as well as several international organisations.31 The EpiSouth Project is a valuable
demonstration that even regions in conflict and with difficult borders can form
effective partnerships, find common ground and engage in commitments to
promote health security.
One Health has expanded beyond its initial primary concern with zoonotics (i.e.
diseases caused by pathogens that can be transmitted between animals and
the NORTHCOM One Health: Environmental Health Considerations for Global Emerging Infectious
Disease and Illness Conference.
30. A.L. Walsh and D. Morgan, “Identifying Hazards, Assessing the Risks”, The Veterinary Record, Vol.
157 (2005), pp. 684–687.
31. M.G. Dente et al., “EpiSouth: A Network for Communicable Disease Control in the Mediterranean
Region and the Balkans”, Euro Surveill, Vol. 14, No. 5 (2009), pp. 1–4.
 Transboundary Planning along the US–Mexico Border 431

humans) to include food- and water-borne disease, the health effects of global
climate change, and the risks of environmental toxins and chronic conditions
such as cancer, obesity and aging.32 This expanded approach to the initial One
Health agenda can be seen in new calls for research proposals. For instance, the
USA’s National Science Foundation (NSF) is encouraging research on the ecologi-
cal, evolutionary and socio-ecological principles and processes that influence the
transmission dynamics of infectious diseases. The NSF issued a call for proposals
seeking projects that focus on “ … the determinants and interactions of trans-
mission among humans, non-human animals, and/or plants. This includes, for
example, the spread of pathogens; the influence of environmental factors such as
climate; the population dynamics and genetics of reservoir species or hosts; or
the cultural, social, behavioral, and economic dimensions of disease trans-
mission.”33 This type of research interrelates spatial scales by taking into account
local–global flows and networks as well as systems and structures.34 Leadership
development, training and new forms of education and governance are important
elements of such efforts.35

Leadership, Training and Workforce Development

Regional public health and environmental challenges require a unified strategy to
ensure well-designed and mutually agreed upon disease surveillance and response
protocols, care coordination for binational patients, and integrated prevention and
health promotion messaging. Policies are developed by leaders at the local, state
and federal levels and require accurate information, careful deliberation, nego-
tiation and consideration of environmental and health impacts. Binational collabor-
ation is constantly evolving, especially considering government transitions,
organisational workforce shifts and new styles of leadership (e.g. community lea-
dership), and within this progression it is vital that leaders seek opportunities for
authentic civic engagement that will lead to positive change. One way this can
be achieved is through understanding of cross-border regional governance, leader-
ship development and binational training programmes to support the develop-
ment of a qualified workforce equipped to deal with the challenges of this
unique space.
Leadership in cross-border health planning is inherently tied to protocols of com-
munication, and awareness of policies, rules and regulations. In the California–Baja
California border region, informal and formal transnational networks exist, encom-
passing non-profit organisations, universities, government and health care
32. Lee and Brumme, op. cit., p. 5; Margalit Younger, Heather R. Morrow-Almeida, Stephen
M. Vindigni and Andrew L. Dannenberg, “The Built Environment, Climate Change, and Health: Oppor-
tunities for Co-Benefits”, American Journal of Preventive Medicine, Vol. 35 (2008), pp. 517–526.
33. National Science Foundation, “Ecology and Evolution of Infectious Diseases (EEID)”, Program
Solicitation NSF 13-577 (November 2013), available: <http://www.nsf.gov/pubs/2013/nsf13577/
nsf13577.htm> (accessed 5 September 2014).
34. On flows, see, for example, Gert Spaargaren, A.P.J. Mol and Frederick H. Buttel, Governing Environ-
mental Flows: Global Challenges to Social Theory (Cambridge, MA: MIT Press, 2006). For network theory,
see, for example, Michele-Lee Moore and Frances Westley, “Surmountable Chasms: Networks and
Social Innovation for Resilient Systems”, Ecology and Society, Vol. 16 (2011), available: <http://www.
ecologyandsociety.org/vol16/iss1/art5/> (accessed 26 June 2014).
35. William Clark, “Sustainability Science: A Room of Its Own”, Proceedings of the National Academy of
Sciences, Vol. 104 (2007), pp. 1737–1738.
432 Keith Pezzoli et al.

agencies to address shared concerns. While both states operate under federal man-
dates and policies, these rules are often adapted to meet the unique needs of the
local and complex border communities. For example, the California–Baja California
region has the highest number of tuberculosis (TB) cases in both countries. At the
local level, public health departments on both sides work closely to ensure care con-
tinuity for every binational, mobile individual living with TB, including those with
multi-drug-resistant TB. Local health departments report new TB cases to the state
to ensure accurate case counting (in Mexico this process also facilitates access to
various treatment options).
Adequately addressing the needs of a border community requires effective trans-
national communication, beginning at the local level and then possibly involving
regional and/or state government, depending on the protocol within that
country.36 Within the US public health system, solutions to public health issues
are managed by the local health department, with the support of the state public
health department and local community partners, while involving federal partners
when necessary.37 In Mexico, under the direction of the National Secretariat of
Health, the state secretariats of health oversee all local and state public health
efforts and policies. Understanding the structure and functions of government
agencies on both sides of the border, especially differences between the US and
Mexico, is necessary to manoeuvre within each system and achieve the desired
outcomes.
The US and Mexico have a long history of collaborating on epidemiologic events
including infectious disease outbreaks, care management of binational patients,
public health laboratory coordination and other issues affecting binational popu-
lations. However, there is still a desire for better electronic systems for sharing
information and formalising cooperative agreements to facilitate regional collabor-
ation.38 The Technical Guidelines for United States–Mexico Coordination on Public
Health Events of Mutual Interest aim to improve communication pathways.39
Public health agencies in the USA and Mexico are often required to communicate
with their agency at the same level in the opposite country (i.e. local–local, state–
state or federal–federal). Timely sharing of information is critical. Currently disse-
mination and training on the guidelines presents a significant challenge and it will
take time before reaching full implementation.40

36. Cecilie Modvar and Gilberto C. Gallopín, Report of the Workshop, Sustainable Development: Epistemo-
logical Challenges to Science and Technology (Santiago, Chile: United Nations, CEPAL, 2004).
37. C. Denman et al., Working beyond Borders: A Handbook for Transborder Projects in Health (Hermosillo,
Sonora, Mexico: El Colegio de Sonora, 2004); M. Zúñiga, “Border Health”, in Sana Loue and Martha
Sajatovic (eds.), Encyclopedia of Immigrant Health (New York: Springer, 2012), pp. 299–305.
38. Zúñiga, op. cit.
39. These Guidelines were developed in 2004 by the Core Group on Epidemiologic Surveillance of the
Health Working Group, U.S. –Mexico Binational Commission and subsequently refined by the U.S.
Centers for Disease Control and Prevention (CDC), Department of Health and Human Services
(HHS) and by the General Directorate of Epidemiology (DGE), Secretaria de Salud (SSA), Mexico.
They can be downloaded at <http://www.cdph.ca.gov/programs/cobbh/Documents/GuidelineforUS-
MexicoEventCoordination.pdf>.
40. Mexico’s Ministry of Health and the Centers for Disease Control and Prevention are currently
establishing a “US-Mexico Binational Communication Pathways Protocol” to facilitate disease-specific,
timely and appropriate communication channels. In one study that examined the efficacy of this new
communication pathway, the authors conclude that “[b]inational notifications using the pilot communi-
cation protocol improve documentation of binational morbidity. In addition, results from pilot partici-
pation suggest that binational reporting is both feasible and beneficial to communication between
 Transboundary Planning along the US–Mexico Border 433

Transborder networks are necessary to create knowledge-action groups to enable

cross-border communication and governance. One successful group in the Califor-
nia–Baja California region is the Border Health Consortium of California—a
member-driven and cross-disciplinary binational initiative that meets regularly
to discuss border health issues, network, disseminate information and explore
opportunities for collaboration. Traditionally, many of these cross-border collabor-
ations have been informal, but there is a growing interest in institutionalising part-
nerships to encourage sustainable and coordinated responses to public health
events.
It is widely recognised that there is a need to train individuals working in the
border region to create a culturally competent workforce. A growing practice to
promote cross-jurisdictional collaboration is the implementation of binational
training programmes, involving cross-border and interdisciplinary teamwork
among trainees (both professionals and students), experiential field work opportu-
nities, and public health and medical student interactions in both countries. These
programmes allow students to directly work together across borders and with
communities on both sides of the border, while making significant contributions
and developing practical skills (e.g. research skills). An example of this type of
binational collaborative training model is the Fogarty International-supported
AIDS International Training Research Program.41
Participants in the Fogarty programme are able to take classes, receive co-mentor-
ing at collaborating institutions and acquire experience in the field of the partnering
country, as well as take advantage of opportunities to engage in long-distance learn-
ing through different technological modalities. Participants gain a deeper under-
standing of systems and cultural differences, which is essential in creating a
culturally competent workforce. Also, investing resources locally, by training stu-
dents and workers rooted in the region, creates more resilient communities.
Another example of a binational collaborative training programme is VIIDAI
(Viajes Interinstitucional de Integración Docente, Asistencial y de Investigación), a
partnership between California and Baja California universities.42 The VIIDAI pro-
gramme is designed for medical students, public health graduate students and
faculty, from both sides of the border, to work collaboratively on public health projects
in under-served communities. Participants visit colonias, which are small farming
towns lacking basic infrastructure, in Baja California. In collaboration with commu-
nity leaders, they address concerns and offer solutions. Activities commonly
include providing medical and dental services, as well as conducting community
needs assessments and health promotion projects. It is a rewarding experience for par-
ticipants as they learn about global health issues and have the opportunity to work
with a multidisciplinary team, learning from leaders, community members as well

public health partners” (Andrew Thorton et al., “US–Mexico Binational Infectious Disease Case and Out-
break Notification Communication Pathway Pilot”, June 2013, available: <https://cste.confex.com/cste/
2013/webprogram/Paper1755.html> [accessed 23 November 2013]).
41. The Fogarty programme is a US–Mexico cross-border training opportunity in HIV, TB and STI pre-
vention and is coordinated by two of the largest universities in the region, the University of California,
San Diego (UCSD) and Universidad Autónoma de Baja California (Autonomous University of Baja Cali-
fornia), with involvement from several partnering institutions including the US–Mexico Border Health
Commission and the Colegio de la Frontera Norte (México’s College of the Northern Border).
42. VIIDAI is a partnership between San Diego State University, UCSD and Universidad Autónoma de
Baja California.
434 Keith Pezzoli et al.

as their peers, and develop skills in cultural competency. It is an advantageous com-

bination of academic, cultural and binational collaboration training.
A third and final example of a binational collaborative training programme
involves civically engaged research led by Alter Terra (a binational non-governmen-
tal organisation [NGO]), the University of California, San Diego (UCSD) Superfund
Research Center (SRC), the Center for US–Mexican Studies, and the Universidad
Autonoma de Baja California (UABC). Alter Terra, UCSD and UABC designed
and implemented a large-scale environmental public health assessment in one of
Tijuana’s rapidly urbanising canyons called Los Laureles. Over the past decade,
the seven mile stretch of Los Laureles Canyon grew in numbers from practically 0
to 70,000 people, many of whom lack basic urban services (e.g. a functioning
sewer system, trash collection, paved roads). As is the case in many of Tijuana’s
canyons, Los Laureles has numerous unregulated dumpsites, containing wastes
from diverse sources (e.g. hospitals, industry, construction, households). Los Laur-
eles Canyon has a south-to-north topographical tilt to it as part of the Tijuana
River Watershed, so although it lies in Tijuana, Mexico, all drainage through the
canyon flows across the US–Mexico border into the USA. During the spring of
2013, UCSD and UABC faculty, researchers and students, assisted by Alter Terra,
carried out 388 face-to-face interviews in targeted neighbourhoods of Los Laureles.43
The survey asked questions about demographics, water hygiene and sanitation,
health-related discomforts and symptoms, disease history, public safety and ser-
vices, and access to medical care. It is the first stage in a long-term epidemiological
plan to causally link exposure to toxicants with health outcomes. The effort is
motivated by the working hypothesis that exposures to hazardous substances (e.
g. in contaminated air, water, land, plants, animals) are taking place and causing
negative health impacts, not only among the canyon’s residents living in close
proximity to the dumps, but also downstream in human and biotic communities
on the US side of the border.

Leadership and Health Diplomacy

Training public health professionals in the area of global health diplomacy and
cooperation is a critical step in bringing leaders together from both countries to
work alongside one another. Health diplomacy is defined as “the chosen method
of interaction between stakeholders engaged in public health and politics for the
purpose of representation, cooperation, resolving disputes, improving health
systems, and securing the right to health for vulnerable populations.”44 There
are currently no standards for training in health diplomacy.
Programmes such as Leaders Across Borders/Líderes Atraves de la Frontera aim to
address this very issue through training public health professionals on how to
work collaboratively binationally. Specifically, Leaders Across Borders is a 10-
43. The survey of 388 households was completed under the direction of co-PIs Wael Al-Delaimy, MD,
PhD (UCSD) and Keith Pezzoli, PhD (UCSD), together with Mexico-based collaborative partner Rufino
Menchaca Díaz, MD, MPH, PhD (UABC). Thirty graduate students from UABC got the training they
needed to do the survey, which they successfully did, door to door, assisted by UABC faculty researchers
and leaders of Alter Terra, namely Oscar Romo and Jennifer Hazard.
44. Kelley Lee and Richard Smith, “What is ‘Global Health Diplomacy’? A Conceptual Review”, Global
Health Governance, Vol. V. No. I (Fall 2011), pp. 1–12, available: <http://www.ghgj.org> (accessed 25
November 2013).
 Transboundary Planning along the US–Mexico Border 435

month programme that teaches and mentors health professionals and community
leaders to design and implement projects to address the needs of under-served
communities in the US–Mexico border region.45 Participants learn how to effec-
tively collaborate with one another by developing skills in health diplomacy and
also gaining a deeper understanding of cultural differences and binational health
care systems. Participants navigate the challenging binational collaboration
process, finding solutions to language and communication barriers, institutional
and cultural differences, and resource imbalances.

Community Knowledge in Civically Engaged Research

No one better understands a community’s needs than those living, breathing and
working within it. Researchers and programme directors are learning that it is
essential to engage members prior to project conception to ensure the services
are tailored to community realities and needs and in order to increase the likelihood
of programme success. This requires new forms of science communication. Signifi-
cant attention is now being focused on the call to transform institutions of higher
education from ivory towers into ivory bridges.46 The intent is to create
“engaged universities” (i.e., knowledge institutions rooted in their region where
use-inspired, problem-solving, solutions-oriented research has as much value as
more traditional basic research).47 The engaged university movement can signifi-
cantly advance the OBROH approach in theory and practice.
A university’s role in society is shifting in the face of globalisation and heightened
competitiveness worldwide among nations and city-regions. On the one hand,
some university leaders and scholars advocate the corporatisation of the
academy following a conservative ethos focused on commercialisation. This
stems in part from the increasing stress being placed on universities to enhance
regional innovation and competitiveness “via harnessing the economic benefit of
science and knowledge, in which the sub-national scale plays an important
role.”48 On the other hand, some university leaders and scholars aim to make the
academy more accountable from social justice and equity standpoints involving
critical pedagogy and civically engaged research and service learning. These two
types of engagement are not necessarily mutually exclusive. Harloe and Perry
argue that these trajectories constitute a mixed bag including opportunities and
threats embodied in conflicts over the university’s mission, internal culture, govern-
ance and allocation of resources.49
The Superfund Research Center (SRC) at UCSD is one example where the effort
to advance civically engaged research is happening. The SRC is integrating
45. The US–Mexico Border Health Commission; the Arizona Department of Health Services, Office of
Border Health; the University of Arizona Mel and Enid Zuckerman College of Public Health; the México
Secretariat of Health; and the Colegios de la Frontera Norte y Sonora support this novel programme.
46. Gerhard Sonnert and Gerald James Holton, Ivory Bridges: Connecting Science and Society (Cam-
bridge, MA: MIT Press, 2002).
47. David Watson, The Engaged University: International Perspectives on Civic Engagement, International
Studies in Higher Education (New York: Routledge, 2011).
48. Michael Harloe and Beth Perry, “Universities, Localities and Regional Development: The Emer-
gence of the ‘Mode 2’ University?”, International Journal of Urban and Regional Research, Vol. 28 (2004),
pp. 212–223.
49. Ibid.
436 Keith Pezzoli et al.

community knowledge and research through a bioregional approach.50 Taking into

account goals spelled out by the US Environmental Protection Agency (EPA)
Border 2020 Program and the GNEB, the UCSD SRC has focused on sites on
both sides of the US–Mexico border. The focus in Mexico has been on Los Laureles
Canyon, a seven mile stretch of canyon land in the Tijuana River Watershed.51 In
the US, the UCSD SRC has focused on San Diego’s Pueblo Watershed contaminated
by diffuse sources of pollution.52

A Forward-Looking Perspective
As the World Health Organization points out, health is not the mere absence of
disease: “Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.”53 Many aspects of health are
related to socio-economic status or mental and psychological well-being even in
the absence of disease. For instance, health quality is partly determined by the
degree to which one enjoys a secure sense of attachment to a safe and convivial life-
place (i.e. rootedness). From this perspective, it is fruitful to join bioregional theory
and practice with the insights and institutional advances made by One Health
advocates. The OBROH narrative helps draw attention to the 21st century’s
socio-ecological stresses and the concomitant need to better align political
economy and ecology. Such an alignment is crucial to the challenge of establishing
healthy place-based planning that can cultivate just, resilient and sustainable com-
munities. A number of trajectories are worth noting here: advances in environ-
mental epidemiology, telecoupling and the articulation of bioregional justice as a
new ethical framework linking health and ecosystems.

Environmental Epidemiology
Contaminants flowing through the environment do not recognise borders. Likewise,
disease vectors are not easily shut down at border checkpoints; disease knows no
border. All of this is forcing public health officials, academicians and researchers to
think differently about how to address human health. The science of environmental
50. UCSD’s SRC, in place since 2000 and recently funded for another five years (to 2017), is generating
new perspectives on the molecular and genetic basis of toxicant exposure, leading to new methodologies
for gauging health risks and assessing health effects—especially among vulnerable populations living
under cumulative stresses associated with poverty. The SRC’s Community Engagement Core is tasked
with linking the SRC’s science to real world applications that benefit vulnerable communities. This
creates opportunities for faculty as well as graduate and undergraduate students to link science to
policy and planning in distressed areas on both sides of the US–Mexico border. The Community Engage-
ment Core aims to advance bioregional justice and sustainability in the San Diego–Tijuana city-region by
enabling students, civically engaged researchers, community leaders and a diverse range of pro-
fessionals to collaborate across academic and jurisdictional boundaries.
51. See Keith Pezzoli, Shannon Bradley, Laura Castenada and Hiram Sarabia, Los Laureles Canyon:
Research in Action (a 28 minute UCSD-TV documentary focused on the water/climate/poverty nexus
in human settlements along the US–Mexico border) (November 2009), available: <http://www.ucsd.tv/
loslaureles/>.
52. See <http://superfund.ucsd.edu/initiative/brownfieldsvacant-lot-asset-mapping-survey>.
53. Preamble to the Constitution of the World Health Organization as adopted by the International
Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61
States and entered into force on 7 April 1948. Available: <http://www.who.int/about/definition/en/
print.html> (accessed 16 April 2014).
 Transboundary Planning along the US–Mexico Border 437

epidemiology will likely become more important over coming decades. Environ-
mental epidemiology, as defined by the National Cancer Institute (USA), “seeks to
understand how physical, chemical, biologic, as well as social and economic factors
affect human health. Social factors—or in other words where one lives, works, socia-
lizes, or buys food—often influence exposure to environmental factors.”54

Telecoupling
Studies that attempt to correlate toxicant exposures with health outcomes in
particular places must grapple with issues of scale posed by globalisation.
The nature of this challenge is captured by the concept of telecoupling. Telecou-
pling, as described by Jianguo Liu et al., is an umbrella concept that refers to
socio-economic and environmental interactions over distances.55 The telecoupling
concept is an outgrowth of Coupled Human And Natural Systems (CHANS)
research, which has been concentrating on human–nature interactions within par-
ticular places. The unit of analysis in telecoupling research is not a discrete place;
rather it is relationships among places (i.e. human–nature interactions in the
space of flows that interdependently bind the fate of people and places across dis-
tances).56 At its 98th annual meeting in 2013, the Ecological Society of America held
a symposium focused on “Ecological Sustainability in a Telecoupled World.”
Enthusiasts of the telecoupling framework (with its emphasis on CHANS, flows,
agents, causes and effects) spelled out its benefits:

The framework can help to analyze system components and their inter-
relationships, identify research gaps, detect hidden costs and untapped
benefits, provide a useful means to incorporate feedbacks as well as
trade-offs and synergies across multiple systems (sending, receiving, and
spillover systems), and improve the understanding of distant interactions
and the effectiveness of policies for socioeconomic and environmental sus-
tainability from local to global levels.57

Bioregional Justice
Human exploitation of the earth’s stocks and flows of natural capital brings up
issues of global and bioregional justice. Bioregional justice shares the concerns of
environmental justice, but does so in a way that also highlights ecosystems as
common good assets, and human–nature relations as manifest in human settlement
patterns at a regional scale. Bioregional justice thus integrates multiple layers of
justice (e.g. social, economic, environmental, global) by advancing a unifying
place-based approach to improving the land, ecosystems and urban–rural relation-
ships in a particular bioregion. Bioregional justice ensures that the benefits, oppor-
tunities and risks arising from creating, operating and living in a territorially
54. National Cancer Institute, “Environmental Epidemiology”, available: <http://epi.grants.cancer.
gov/environmental/> (accessed 23 November 2013).
55. Jianguo Liu et al., “Framing Sustainability in a Telecoupled World”, Ecology and Society, Vol. 18, No.
2 (2011), pp. 1–19.
56. Ibid.
57. Ibid.
438 Keith Pezzoli et al.

bounded network of human settlements (i.e. a bioregion where urban–rural–wild-

land spaces co-evolve socially, culturally and ecologically) are shared equitably
through healthy relationships and secure place-based attachments. Bioregional
justice seeks equity and fairness in how a bioregion’s assets—including nature’s
sources, sinks and ecosystems needed for life and living—are accessed, utilised
and sustainably conserved for current and future generations.
Bioregional justice is a normative theory at the heart of the OBROH narrative.
Bioregional justice elevates the visibility and significance of ethics with respect to
community health and land. Aldo Leopold’s land ethic resonates here: “A thing is
right when it tends to preserve the integrity, stability, and beauty of the biotic com-
munity. It is wrong when it tends otherwise.”58 Leopold understood that land is
more than soil; it is “a fountain of energy flowing through a circuit of soils,
plants, and animals.”59 The land ethic (like OBROH) “enlarges the boundaries of
the community to include soils, waters, plants, and animals, or collectively: the
land.”60 Establishing an ethic to realise bioregional justice (i.e. a place-based ecopo-
lity where fairness and healthy resilience prevails in how we relate with one another
and with the land, waters, habitat, plants and animals upon which we depend) is not
just an ecological challenge; it is also a socio-political, economic, cultural and aes-
thetic challenge. The great urban and regional visionary Lewis Mumford stated
this view poignantly over three-quarters of a century ago (a perspective as relevant
today as it was then): “The re-animation and re-building of regions, as deliberate
works of collective art, is the grand task of politics for the coming generation.”61

Conclusion
OBROH is an integrative approach that aims to improve human and environ-
mental health through knowledge networking, ecosystem management, commu-
nity participation in science–society relations, leadership development and cross-
disciplinary training. OBROH is redefining how we understand human–nature
relationships in the quest for healthy place making. But there is a long way to
go. Linking local and bioregional/global information in a pragmatic manner is a
major challenge. For instance, as local entities undertake urban ecological restor-
ation projects, it would help if they knew how their efforts fit into larger, bioregio-
nal ecological restoration efforts and activities (e.g., could the use of multiple
vacant lots for community-based urban agriculture and rainwater harvesting
within a particular watershed be configured in such a way that it adds value to
food and water security on a bioregional scale?). Three science–society gaps
thwart the equitable co-production, access and use of knowledge necessary to
address questions of this sort. The three gaps are:
1. Epistemic (gaps within and between formal and informal knowledge
ecosystems)
2. Analytical (gaps between global, regional and local scale data)
3. Socio-economic (gap between those with technical resources and those without)
58. Aldo Leopold, “The Land Ethic”, in A. Light and H. Rolston III (eds.), Environmental Ethics (Oxford:
Blackwell, 2003), p. 39.
59. Ibid.
60. Ibid.
61. Lewis Mumford, The Culture of Cities (London: Routledge/Thoemmes, 1977), p. 348.
 Transboundary Planning along the US–Mexico Border 439

Narrowing these gaps requires new socio-technical systems (using big data
informatics, visualisation and mapping techniques) that can illuminate how built
environments, ecosystems and health interact across spatial and temporal scales.
Narrowing these gaps also depends on an active civil society including mutually
reinforcing community–university engagement and equitable public–private part-
nerships that can generate new types of use-inspired, solutions-oriented research
and action. OBROH is an emergent approach that seeks this kind of engagement
and partnership building—especially in the context of enabling ecological restor-
ation and healthy place making that is sustainable and resilient.

Funding and Acknowledgements

The US National Institute of Environmental Health Sciences (NIEHS) of the
National Institutes of Health (NIH) under Award Number P42ES010337 sup-
ported some of the research reported in this article. The content is solely the
responsibility of the authors and does not necessarily represent the official
views of the NIEHS, NIH or any of the other agencies to which the co-authors
have affiliation.

About the Authors

Keith Pezzoli, PhD, is Director of the Urban Studies and Planning Program at the
University of California, San Diego (UCSD). Pezzoli leads the UCSD Superfund
Research Center’s Community Engagement Core with projects focused on socio-
ecological challenges and health along the US–Mexico border. Pezzoli founded
The Global Action Research Center (The Global ARC), a not-for-profit organisation
that connects researchers to communities in pursuit of rooted community and resi-
lient bioregional development.

Justine Kozo, MPH, is Chief of the Office of Border Health for the County of San
Diego, Health and Human Services Agency. Under her direction, the office aims
to increase communication and collaboration among organisations working in
the California–Baja California border region to address public health concerns.
In collaboration with the California Office of Binational Border Health, she also
facilitates meetings and activities of the Border Health Consortium of the
Californias.

Dr Karen Ferran is the former Chief Epidemiologist/Program Manager of the Early

Warning Infectious Disease Surveillance (EWIDS) Program of the California
Department of Public Health. Her work focuses on pandemic influenza, emerging
and re-emerging pathogens, and agents of bioterrorism. Dr Ferran co-founded One
Border One Health and is co-chair of the Surveillance Committee. She is a lecturer
at San Diego State University in the Graduate School of Public Health and is cur-
rently developing the One Health curriculum.

Wilma Wooten, MD, MPH, is Public Health Officer and Director of Public Health
Services for the County of San Diego Health and Human Services Agency (HHSA).
She oversees approximately 500 employees and a budget of over $110 million,
440 Keith Pezzoli et al.

serving a county of approximately 3.2 million residents. Dr Wooten is a board

member for the California Conference of Local Health Officers (CCLHO), the
Health Officers Association of California (HOAC) and the Public Health Accredita-
tion Board (PHAB).

Dr Gudelia Rangel Gomez is currently in charge of the Office of the Executive Sec-
retary of the US–Mexico Border Health Commission, Mexico Section. She is also
Deputy Director General for Migrant Health of the Secretary of Health. From
2003 to 2007, she served as Director of the Department of Population Studies and
later as General Director of Academic Affairs in the College of the Frontera
Norte in Baja California.

Wael K. Al-Delaimy, MD, PhD, is Professor and Chief, Division of Global Health in
the Department of Family and Preventive Medicine, the University of California,
San Diego. His work is focused on environmental epidemiology and exposure
assessment and in the US–Mexico border area he has worked on pesticide exposure
among farm workers. Prior to coming to UCSD he was a scientist at the Inter-
national Agency for Research on Cancer in Lyon, France, and Post-Doctoral
Research Associate at Harvard School of Public Health.